Ophthalmic Hospitalist Set Up Q&A
Q: Who should consider a career as an ophthalmic hospitalist?
A: Ophthalmic hospitalists can be either comprehensive or fellowship trained. Some providers start this position right after residency while others transition after years of private practice. The bottom line is that many different backgrounds can be a great fit! In general, people enjoy managing active, potentially complex ocular conditions that often reflect underlying systemic disease. Collaboration with other hospital services and multi-disciplinary care are an engaging part of our work.
Q: Do you have residents or support staff on your service?
A: Many ophthalmic hospitalists practice at academic institutions and work closely with either a first or second-year resident who is assigned to a dedicated consult rotation. For other models of healthcare such as private or Kaiser, support staff such as a medical assistant, technician, or optometrist can also assist an ophthalmic hospitalist with consult coverage.
Q: What is the best way to schedule/plan to see consults?
A: Consults by nature are unpredictable! Some days will be busier than others. Many providers will round with a resident at a specific time each day of the week. The majority of inpatient consults are evaluated at bedside. In some circumstances patients can be transported to the eye clinic (if connected to the hospital) or to a designated eye room within a hospital that is equipped with a slit lamp and other useful items.
Q: What structure is best for subspecialty coverage?
A: Many hospitalists work at academic institutions where fellows can assist with complex cases. If fellows are not available, an ophthalmic hospitalist can discuss patients with subspecialty providers who are ideally available to also come in and evaluate a patient when needed. Subspecialties that are particularly important for bedside availability are retina (endophthalmitis) and oculoplastics (trauma).
Q: How do you incorporate teaching or research into your consult service?
A: Educating medical students, residents, fellows, and other hospital divisions can be a wonderful part of this career. With such a wide variety of ocular pathology in the hospital and ER, teaching opportunities are plentiful. Some providers carry a portable IPAD with consult cases to discuss when rounding. Others are involved with lectures such as “ocular manifestations of systemic disease” and trauma surgical wet labs. Consults are also a great place for research including case reports or quality metrics for ophthalmic hospital-based care. Please refer to our links for further information: https://ohig.org/resident-teaching, https://ohig.org/hospital-lectures
Q: Is it feasible to do both clinic and consults to maintain specific skills?
A: The answer is yes – we know providers who do both! Although many ophthalmic hospitalists may choose to focus their efforts solely on hospital/ER based care, others enjoy a combination of both consults and clinic/OR. We do recommend that you find a schedule that is sustainable since it can be challenging to handle both a busy consult and outpatient clinical service. Providers often schedule their outpatient clinic/OR in the morning so that afternoons can be reserved for hospital consults which are less predictable.
Q: How do you arrange for consult coverage for after hours, holidays, sick/vacation time?
A: Many ophthalmic hospitalists are available on pager from 7am-5pm on weekdays. They can integrate their schedule with an existing call pool of other providers who are back up during off periods or offer surgical coverage when needed. If you happen to practice at an institution with multiple ophthalmic hospitalists, you have the benefit of arranging coverage within an internal group of hospitalist providers.
Q: Would you recommend salary vs productivity-based compensation for an ophthalmic hospitalist?
A: Many ophthalmic hospitalists are salary based or have a combination of salary and productivity-based income. Due to the unpredictable volume of consults and variety of payer insurance for hospitalized/ER patients (many of whom can be uninsured), productivity-based reimbursement alone could be inconsistent.
Q: How do you obtain funding for consult services?
A: It is reasonable to negotiate an annual consult budget through your department or hospital. This fund would cover the cost of eye drop medications, equipment (indirect, tonopen, sutures, etc), and surgical instruments.
Q: How do you sterilize surgical instruments on consults?
A: There are various bedside surgical procedures which may be required including emergent lateral canthotomy/cantholysis, eyelid laceration repair, intravitreal injection, etc. We highly recommend carrying a dedicated used instrument case in the call bag to help prevent inadvertent injuries. Surgical instruments can often be sterilized through your department or hospital sterilization unit. If this is not available, Katena offers a variety of disposable single use surgical instruments: https://www.katena.com/products/blink-disposables/blink-disposables
Q: What equipment do you think is important to have on the consult service?
A: Great question! Please refer to our resident education page which lists helpful suggested items for consults: https://ohig.org/resident-teaching